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      Fibroepithelial Polyp of the Vagina With Torsion: A Difficult Diagnosis Based on Clinical and Morphological Findings of the Vaginal Lesion

      case-report

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          Abstract

          Vaginal fibroepithelial polyps are rare benign tumors of the mucosa of the anterior vaginal wall. In extremely rare cases, they may originate from the posterior vaginal wall or be complicated by torsion. Our case concerns a 63-year-old patient who presented to the gynecology outpatient clinic of the General Hospital of Trikala with minor vaginal bleeding. On vaginal examination, a large pedunculated painless hemorrhagic polypoid mass was noticed, originating from the posterior vaginal wall. A torsion of the pedunculated vaginal tumor was suspected, leading to its surgical excision with clear resection margins. Due to extensive tissue necrosis, accurate histological identification of the vaginal neoplasm was not possible. Histological examination excluded vaginal malignancy. Based predominantly on the clinical and morphological features of the vaginal lesion, a diagnosis of vaginal fibroepithelial polyp with torsion was made, acknowledging its limitations. The patient was discharged from the clinic the same afternoon following the surgery. Three months later, no recurrence of the lesion in the vaginal wall was noted. Following the case presentation, this paper provides a brief literature review of this rare entity, focusing on the diagnostic and therapeutic approaches.

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          Most cited references18

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          Staging for vaginal cancer

          Vaginal cancer is a rare cancer comprising about 3% of all gynecologic cancers. Primary vaginal cancer should be carefully assigned as spread from cervix, vulva, and other metastatic tumors to vagina can occur. Although vaginal cancer traditionally occurs in older postmenopausal women, the incidence of high-risk human papillomavirus (HPV)-induced cancers is increasing in younger women. Squamous cell carcinoma is still the most common histopathologic type followed by adenocarcinoma. With decreasing use of diethylstilbestrol in pregnancy, non-diethylstilbestrol-associated cancers are described. The Federation Internationale de Gynecologie et d'Obstetrique (FIGO) staging of vaginal cancer (2009) follows the same rules as cervical cancer; it is clinically staged and allows the use of routine investigative modalities for staging. Although FIGO encourages the use of advanced imaging modalities, such as computed tomography, magnetic resonance imaging (MRI), and positron emission tomography (PET), to guide therapy, the imaging findings may not be used to change or reassign the stage. TNM staging is the pathologic staging system proposed by the American Joint Committee on Cancer, and information available from examination of the resected specimen, including pelvic and inguinal lymph nodes, may be used for staging.
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            A review and update of morphologically bland vulvovaginal mesenchymal lesions.

            Vulvovaginal mesenchymal lesions composed of morphologically bland spindle-shaped cells often pose a particular diagnostic problem for the surgical pathologist not only because of the rarity of these lesions but also because of the wide array of entities with overlapping morphologic features. Included in this group of lesions are soft tissue neoplasms that may arise at any site and those that are characteristic of, or relatively specific to, the vulvovaginal region. Lesions that are relatively specific to the vulvovaginal region include well-known neoplasms such as aggressive angiomyxoma and angiomyofibroblastoma as well as more recently described lesions such as cellular angiofibroma and superficial cervicovaginal myofibroblastoma. Fibroepithelial stromal polyp, superficial angiomyxoma, and smooth muscle neoplasms also can occur in, but are not specific to, this site. In this review, the clinicopathologic features of these lesions are described with an emphasis on recent developments. The value of ancillary studies, especially immunohistochemistry, is discussed, although it is stressed that in general these are of limited value and routine morphology remains the mainstay in diagnosis. Morphologically bland spindle cell lesions that are not characteristic of the vulvovaginal region, but which also may occur here, are briefly discussed as are a variety of extremely rare mesenchymal lesions that have recently been described at this site.
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              Cancer of the vagina: 2021 update

              Diagnosis of a primary vaginal cancer is rare, as most vaginal tumors are metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This is associated with persistence of high‐risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, as with cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer. A review of the different histologic subtypes of primary vaginal cancer in terms of staging and role of imaging, as well as treatment options and prognoses.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                28 February 2024
                February 2024
                : 16
                : 2
                : e55157
                Affiliations
                [1 ] Department of Histology, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
                [2 ] Department of Anatomy, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
                [3 ] Department of Obstetrics and Gynecology, General Hospital of Trikala, Trikala, GRC
                [4 ] Department of Obstetrics and Gynecology, Limassol General Hospital, Limassol, CYP
                [5 ] Department of Obstetrics and Gynecology, EmbryoClinic In Vitro Fertilization (IVF) Unit, Thessaloniki, GRC
                [6 ] Department of Obstetrics and Gynecology, University of Thessaly, Larissa, GRC
                Author notes
                Article
                10.7759/cureus.55157
                10980332
                38558656
                7f952d81-cffa-47c4-a7d2-f85fe755194f
                Copyright © 2024, Thanasa et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 28 February 2024
                Categories
                Obstetrics/Gynecology
                Oncology

                vaginal fibroepithelial polyp,torsion,clinical findings,histological diagnosis,surgical treatment,case report

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